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MEDICAL TECHNOLOGY INNOVATION WILL CONTINUE UNDER HEALTH CARE REFORM

This article was originally published in The Gray Sheet

Executive Summary

MEDICAL TECHNOLOGY INNOVATION WILL CONTINUE UNDER HEALTH CARE REFORM, Rep. John Dingell (D-Mich.) said in a Sept. 29 luncheon address at the National Press Club in Washington, D.C. The House Energy and Commerce Committee Chairman discounted concerns voiced by device manufacturers, which contend that the global health budgets and insurance premium limits included in the administration's plan would stifle innovation ("The Gray Sheet" Sept. 27, p. 7). "Within a competitive, trillion-dollar industry [which is] growing toward $2 tril. within six years at a rate exceeding the rate of inflation," Dingell proclaimed, "there will continue to be an enormous number of opportunities for entrepreneurs to develop breakthrough drugs, devices and wonderful new techniques of delivery." Despite his long-standing preference for a single-payer approach to reform, the Michigan Democrat stated that he supports "with great enthusiasm" Clinton's managed competition plan for health care reform. Dingell added that he is "wildly optimistic" about the prospects for enacting health care reform. "I think the political miracle will occur in the 103rd Congress, and before the 104th meets we will be able to congratulate ourselves that we have done something good for the country," he predicted. Acknowledging the enormity of the task before Congress, however, Dingell quipped that, in comparison to national health care legislation, the debate over the Clean Air Act will "look like a commemorative stamp resolution." Calling health care reform "the last major component of the New Deal" and himself "the last remaining New Dealer in Congress," Dingell said: "I am prepared to move heaven and earth in the Energy and Commerce Committee to see to it that health care reform passes." However, Congress will have to make "bold choices" that "cannot satisfy everyone," he acknowledged. "If cost containment works, providers will be unhappy; if a service -- needed or not -- is a bit harder to get, reform will be blamed." Countering criticism that the health reform plan will lead to rationing of medical services, Dingell contended that "this country confronts rationing of health care right this minute. We ration between the rich and the poor." Rep. Dan Rostenkowski (D-Ill.), chairman of the Ways and Means Committee which shares primary jurisdiction in the House over health care reform legislation with the Energy and Commerce Committee, commented on the issue of rationing at a National Federation of Specialty Nursing Organizations meeting Sept. 28. "Hovering quietly above this debate is a widespread realization that we spend an inordinate amount of money treating people who are clearly dying and who cannot be saved at any cost," he stated. The Illinois Democrat called the reform effort "a major positive opportunity" to reassess the appropriateness of health care services. Debating reform, he added, "gives us a chance to create a system with less technology but more humanity...[That's] good news for those who want a system that has more compassion and fewer thoughtless or useless traumatic procedures." The House Energy and Commerce and Ways and Means panels were among five congressional committees to hold hearings on the White House health reform plan the week of Sept. 27. The other hearings were held by the Senate Finance, Labor and Human Resources, and Education and Labor Committees, which all called on First Lady Hillary Rodham Clinton to testify on the reform plan. Speaking before the Labor and Human Resources Committee, chaired by Edward Kennedy (D-Mass.), Clinton downplayed the regulatory authority of the National Health Board that would be created under the plan. "The national board is meant to be a coordinating and advisory board," she said. "If the way we have described some of its functions sound too regulatory, we ought to look at that. That has not been our intention." The First Lady's comments came in response to a statement by Sen. Judd Gregg (R-N.H.), who said that "the power that is being laid at the feet of this national board is awesome." Gregg asserted that the scope of the authority granted the board under the administration's draft makes its "level of influence" akin to that of the Supreme Court. As envisioned in an initial draft outline of the White House plan, National Health Board powers include the ability to "interpret and update" the standard benefits package, to set and enforce a national health budget, and to establish and oversee a quality management program ("The Gray Sheet" Sept. 20, p. 15). The Health Industry Manufacturers Association also has voiced concern with the board's authority, asserting that its power "cannot be overstated." Clinton raised some concerns with the Senate Republican health reform bill at the Sept. 30 Senate Finance Committee hearing. "If we have a legislatively required individual mandate" as proposed by the Senate health reform task force ("The Gray Sheet" Sept. 20, p. 19), "we worry that the number of people who currently are insured through their employment will decrease," she said. The administration also has "great concern," Clinton remarked, "about how the administrative structure to track the individual contribution...would be set up." Regarding the administration's plans for overall health care spending under health care reform, the First Lady told the Senate Finance panel that "we are thinking of zero growth as a budget target this country should be moving toward." Under the initial draft of the plan, health alliance budget increases would be held to the growth in the consumer price index beginning in 1999. The First Lady said at an Energy and Commerce hearing Sept. 28, however, that the health care reform plan has "enough leeway that, if we decide a [gross domestic product] growth rate...should be phased in more gradually [as a health cost limit], we think we can do that. But we want to start with the firm conviction that there is waste in the system, there is better utilization that we can obtain in this system, and there is better quality to be given." Congressional hearings on health care reform will continue in the coming weeks. At least two hearings, of the House Ways and Means Committee, and the House Energy and Commerce health subcommittee, are scheduled for the week of Oct. 4. HHS Secretary Donna Shalala is slated to testify at both hearings.
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